Academic literature on the topic 'Intercondylar notch'

SummaryThis prospective study evaluated the intercondylar notch width in dogs with naturally occurring cranial cruciate ligament (CCL) injuries. The intercondylar notch width was measured in 45 stifles with CCL injuries and 98 normal stifle joints to determine if stifles with CCL injuries have outlet stenosis of the intercondylar notch. A notch width index was calculated in order to compensate for the variety of dog sizes. Stifles with CCL injuries had significantly smaller notch width indices as compared to normal stifles. We concluded that intercondylar notchplasty should be performed if an intra-articular repair of the CCL deficient stifle is planned in order to minimize impingement of the stenotic intercondylar notch on the intra-articular graft.An intercondylar notch width index was determined in 45 stifles with cranial cruciate ligament (CCL) injuries and 98 normal stifle joints. Stifles with CCL injuries were found to have significantly smaller intercondylar notch width indices as compared to normal stifles.

SummaryThis study was conducted to evaluate the clinical application of computed tomography of the canine femoral intercondylar notch. The canine femoral intercondylar notch is angled 12 degrees from the dorsal plane and obliqued 7 degrees proximolateral to distomedial in the sagittal plane. Measurements of the notch were performed with eight, 12, and 16 degrees of gantry tilt. With the exception of proximal opening notch angle, significant differences were not detected in measurements referenced to 12 degrees of gantry tilt. Evidence from this study indicated that a ± 4 degree variation in gantry tilt angle from a desired angle of 12 degrees did not significantly affect clinical interpretations of intercondylar notch measurements or notch width index ratios.

Background/Aim. Morpohometric parameters of the intercondylar notch of femur present one of the substantial risk factors for rupture of the anterior cruciate ligament (ACL). In morphometric studies of the knee the most often referred indexes are notch width index and notch shape index. The aim of this study was to identificate the morphometric parameters of the intercondylar notch as risk factors for ACL rupture. Methods. This study included 99 patients divided into two groups: the study group (n = 57) composed of patients with chronic instability of the knee because of previos rupture of the ACL, and the control group (n = 42) composed of patients with lesion of the knee, but without rupture of the ACL. Measuring the width and height of intercondylar notch and epicondylar width was observed on a horizontal MR section. According to these values notch width and notch shape indexes were calculated. Results. The study group had statistically significantly higher (p < 0.05) intercondylar notch and lesser notch shape index than the control group (p < 0.05). The difference was highly statistically significant (p < 0.01) only in males, but not in females (p > 0.05). Absolute dimensions of the morphometric parameters of the distal part of the femur had highly statatistically significant larger values (p < 0.01) in males than females, exept in case of the intercondilar height in the control group (p > 0.05). Conclusion. Enhanced height of the intercondylar notch as well as lesser value of the notch shape index are associated with rupture of the ACL in males but not in females.

SummaryIn the human and veterinary orthopaedic literature it has been implied that intercondylar notch stenosis is a mechanical factor in cranial cruciate ligament rupture and intraarticular graft failure. The patients in this study were classified as normal (32), unilateral cruciate rupture (23), or bilateral cruciate rupture (17). The dogs were placed under general anaesthesia and both stifles were scanned via computed tomography (CT) as previously described. Three CT slices at predetermined levels were evaluated within the notch. Measurements included opening notch angle, notch width and height, condyle width, and notch width index (notch width/ condyle width) at two different heights within the notch. Intercondylar notch measurements at the most cranial extent were significantly more narrow in unilateral and bilaterally affected stifles when compared to the normal population. Significant differences were noted in the opening notch angle (ONA), notch width index (NWI), NWI at two thirds notch height (NWI2/3), and tibial slope index (TSI). No significant differences were noted between unilateral and bilateral affected stifles. Increased mechanical contact of the cranial cruciate ligament with a stenotic intercondylar notch may predispose the ligament to mechanical wear and structural weakening. Intercondylar notch measurements have been used as a tool to predict the risk of anterior cruciate ligament injury in young human athletes, and to assess the risk factors for intra-articular graft replacements. Our findings may be useful in developing similar predictive models using stifle CT scans.

Introduction: Narrow intercondylar notch of femur can lead to lean anterior cruciate ligament on femur's condyle, constraint and rupture. Purpose: Purpose of this study is description and comparasion gender and oldage differences of morphometric factors of intercondylar notch important for rupture LCA. Method: The measurements were taken on 50 cadaverous knees (32 male and 18 female) with intact anterior cruciate ligament, aged from 15 to 53 years. We measured intercondilar height and epicondylar width, intercondylar width, width of lateral and medial condyle in level of popliteal sulcus and on the widest place of the distal part of femur. We calculated notch width (NWI) and notch shape (NSI) indices from absolute measurements. Results: Notch width and epicondylar width have larger values (p<0.01) on the male (22.3 i 79.6 mm) than the female (18.2 i 68.7 mm). There is no statistical significant differences (p<0.05) about notch width and notch shape indices between male (NWI: 0.28; NSI: 0.77) and female (NWI: 0.27; NSI: 0.68). Aging epicondylar width rise.

The compressive and shear stiffness of periarticular osteophytes, hypertrophic femoral intercondylar notch and normal articular cartilage were compared by obtaining force-indentation curves and applying a shear force to the cartilage/bone interface. The primary stiffness (at 0–100N load) was similar for osteophytes (391N/mm), intercondylar notch (400N/mm) and normal articular cartilage (401N/mm). By contrast, the secondary stiffness (at 100–500N load) was much higher for the intercondylar notch (493N/mm) compared to the osteophytes (410N/mm). There were two varieties of osteophytes, "pink" and "white". Compared with "pink" osteophytes, "white" osteophytes exhibited features similar to a progressively hardening material and appear to be a more mechanically suitable material as an osteochondral graft for full thickness articular cartilage defect. The shear characteristics of all the samples were similar.

Background A recent report of professional women's basketball found that white European American female players were 6.5 times more likely to tear their anterior cruciate ligament than their nonwhite European American counterparts. African Americans accounted for 95% of the nonwhite European American group. Hypothesis African American men and women have wider intercondylar notches than white men and women. Study Design Cohort study (prevalence); Level of evidence, 2. Methods We obtained 45° flexed weightbearing posteroanterior radiographs on 517 patients who had knee problems other than an anterior cruciate ligament injury or arthrosis. One experienced observer measured the intercondylar notch width with no knowledge of race or gender, and the measurements were analyzed based on race and gender. Results The mean intercondylar notch width was 15.5 mm (SD = 2.8; range, 9-22) for African American women and 14.1 mm (SD = 2.5; range, 8-21) for white women; this difference was statistically significant (P = .009). Similarly, the mean intercondylar notch width was 18.0 mm (SD = 3.6; range, 10-27) for African American men and 16.9 mm (SD = 3.1; range, 9-27) for white men; these values were statistically significantly different (P = .003). Conclusion We conclude that African Americans have statistically significantly wider intercondylar notch widths on 45° flexed weightbearing posteroanterior radiographs than whites of the same gender. This relationship may offer an explanation for the difference between races with regard to risk of anterior cruciate ligament tears.

The most important anatomic risk factors in ACL lesions are the morphometric parameters of intercondylar notch. In the morphometric studies index of notch width and index of notch shape (NWI and NSI) are commonly used. The certain morphologic parameters of distal femoral part are used in calculation. Beside standard parameters we measured the maximal width of intercondylar notch and distal part of femur, which we used for calculation of maximal index of notch width and maximal index of notch shape (NWI max and NSI max). We compared two different methods of calculation of intercondylar notch indexes to find out which one represent anatomic risk factor and influence the ACL lesions. The indexes were measured in the two groups of patients (33) who have the history of knee injuries, the first group has document of ACL injuries and the second without ACL injuries (control one). The important difference between two groups was founded in NWI (p<0.01) and NSI (p<0.05). NWImax and NSImax do not show the difference (p>0.05). The NWI and NSI importance is higher in males, and smaller in females. There is no difference in NWImax and NSImax (p>0.05) comparing to the gender.

Osteoarthritis (OA) is the leading cause of disability in North American and has major economic consequences for society. People with knee OA experience the worst quality of life, among musculoskeletal conditions, with function and mobility being influenced by symptoms such as pain and stiffness. However, the impact of OA symptoms varies due to intrinsic and extrinsic factors, leading many researchers to employ biopsychosocial and other population health frameworks to study the disease. These population health approaches have not been adopted when studying knee OA outcomes in bioarchaeology, where a limited biological lens prevails due to the sole reliance on skeletal remains. The purpose of this research was to explore methods for identifying the impairment potential of knee OA in archaeological populations using a clinical sample and population health approaches. Clinical studies have the advantage of assessing not only the biological implications of knee OA but also the functional outcomes. By creating a knee OA grading system applicable for both MRI and dry bone femora samples (Clinical Archaeological Osteoarthritis Score) a link between clinical and archaeological populations was proposed. Using this link to infer functional deficits onto archaeological populations using population health frameworks, a theoretical analysis was performed with two populations; the 17th century Huron and the 19th century Inuit from the Igloolik region of Nunavut. The results demonstrated the increased impairment potential of knee OA in the Inuit population versus the Huron population, produced by contrasting factors captured by the determinants of health, including social and physical environments.

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
Introdução: O posicionamento não anatómico dos túneis ósseos está associado a um maior risco de rotura da plastia e, consequentemente, de cirurgia de revisão. No entanto, o impacto real das variações do posicionamento não está de todo determinado. O presente estudo pretende, através da avaliação morfométrica das radiografias do joelho e da avaliação clínica, verificar se pequenas variações do posicionamento dos túneis femoral ou tibial se traduzem em alterações clínicas ou funcionais dos doentes.Métodos: Foram incluídos no estudo 49 doentes submetidos a cirurgia de reconstrução primária do ligamento cruzado anterior, em que não houve a necessidade de cirurgia de revisão e/ou reoperação. Através da análise retrospetiva dos processos clínicos, foram recolhidos dados demográficos e clínicos. Procedeu-se à avaliação das imagens radiográficas obtidas em contexto pré- e pós-operatório. Na radiografia pré-operatória, determinou-se o grau de artrose pela classificação de Ahlback, o eixo epifisário de Dejour e Levigne, a inclinação tibial, a morfologia da linha de Blumensaat e a báscula epifisária femoral (BEF). Na radiografia pós-operatória, foi medido o posicionamento da plastia no fémur e na tíbia, o ângulo da plastia com a interlinha articular e a divergência ou convergência dos túneis ósseos. A avaliação funcional subjetiva foi feita através do SF-36 (Short Form Health Survey), da escala de Lysholm e Tegner e dos questionários de avaliação subjetiva do joelho: IKDC (International Knee Documentation Committee) e KOOS (Knee Injury and Osteoarthritis Outcome Score).Resultados: Na maioria dos doentes (65.3%; n=32), a linha de Blumensaat apresentava um padrão retilíneo. Entre os que apresentavam um padrão em pequena ou grande colina (34.6%, n=17), a percentagem média da colina foi de 47.3%. A média da BEF nos doentes com um padrão retilíneo, em pequena colina e grande colina da linha de Blumensaat foi de 32.4º, 29.4º e 27.3º, respetivamente. O teste Kruskal-Wallis identificou diferenças estatisticamente significativas entre a BEF e os diferentes padrões morfológicos da linha de Blumensaat (H=6.6; p=0.037). Relativamente ao posicionamento do túnel femoral, as pontuações medianas das dimensões S (H=34.0; p=0.017) e QV (F=3.6; p=0.036) do KOOS apresentaram diferenças significativas de acordo com a zona femoral (ZF).Discussão: O padrão morfológico em grande colina da linha de Blumensaat está associado a valores inferiores da BEF. Não foi encontrada diferença estatisticamente significativa entre a BEF ou o padrão da linha de Blumensaat e o resultado clínico. Contudo, o posicionamento mais anterior do túnel femoral está associado a valores de KOOS-S e KOOS-QV inferiores.Conclusão: Os valores da BEF correlacionam-se com o padrão morfológico da linha de Blumensaat, apesar de não se traduzir num resultado clínico inferior. No entanto, existe uma correlação entre o posicionamento do túnel femoral e os valores de KOOS-S e KOOS-QV.
Introduction: Non-anatomic tunnel position is associated with an increased risk of primary ACL reconstruction failure and, consequently, need for surgical revision. However, the actual impact of tunnel position is not entirely determined. The aim of this study is to verify whether small variations of femoral and tibial tunnel position are associated with worse clinical or functional outcome, through radiographic and clinical evaluation.Methods: The cohort included 49 patients who underwent primary ACL reconstruction, without being submitted to revision and/or reoperation surgery. Retrospective analysis of patients’ clinical data allowed to characterize the cohort in both clinical and demographic terms. Pre and post-operative radiographic evaluation were conducted. In the first radiological analysis, knee join osteoarthritis (according to the Ahlack classification), epiphyseal axis defined by Dejour and Levigne, posterior tibial slope, Blumensaat’s line morphology and the femoral epiphyseal scale (BEF) were analyzed. In the postoperative radiography, femoral and tibial tunnels were determined as well as the graft angle and the divergence of bone tunnels. Functional outcome was assessed using SF-36, Lysholm score, IKDC subjective knee form and KOOS 3.8 years after surgery. Results: In most cases (65.3%; n=32), the Blumensaat’s line was straight. When classifying the Blumensaat’s line in small and large hill types (34.6%, n=17), the mean percent of the protrusion was 47.3%. The mean value of the femoral epiphyseal scale (BEF) in patients with straight, small hill and high hill types was 32.4º, 29.4º e 27.3º, respectively. Kruskal-Wallis test found a significant statistical difference between BEF and morphologic variations of the Blumensaat’s line. (H=6.6; p=0.037). When analyzing the femoral tunnel position, significant difference was found in KOOS subscales such as the median values of symptoms (S) (H=34.0; p=0.017) and quality of life (QoL) (F=3.6; p=0.036) depending on the femoral zone (FZ). Discussion: Considering the morphological variations of the Blumensaat’s line, large hill type is correlated with lower femoral epiphyseal scale values. No differences in clinical outcome were found when comparing BEF or Blumensaat’s line morphology with the functional outcome. However, anterior femoral tunnel position is associated with lower KOOS-S and KOOS-QoL subscales score.Conclusion: Study results strongly suggest that femoral epiphysial scale (BEF) is correlated with Blumensaat’s line morphology. No correlation was found between BEF or Blumensaat’s line morphology and the functional outcome. However, a significant difference was found between femoral tunnel position and KOOS-S and KOOS-QoL subscales score.

Intercondylar notch impingement is detrimental to the anterior cruciate ligament (ACL). Notchplasty is a preventative remodeling procedure performed on the intercondylar notch during ACL reconstruction (ACLR). This study investigates how ACL graft geometry and both tibial and femoral insertion site location affect ACL-intercondylar notch interactions post ACLR. A range of ACL graft sizes are reported during ACLR, from 6mm–11mm in diameter. Minor variability of up to 3mm in ACL insertion site locations is reported during ACLR. Several 3D finite element (FE) knee joint models were constructed using three ACL graft sizes and polar arrays of tibial and femoral insertion site locations. Each knee model was subjected to flexion, tibial external rotation, and valgus motion. Impingement force and contact area between the ACL and the intercondylar notch compared well with published cadaver study results. A 3mm shift in the antero-lateral direction of the tibial insertion site of the average and maximum size ACL increased impingement force by 155.4% and 242.9% respectively. A 3mm shift in the anterior-proximal direction of the femoral insertion site of the average and maximum size ACL increased impingement by 292.6%, and 346.2% respectively. Simulated notchplasties of 4mm and 5mm reduced graft impingement force by 89.4% and 100% respectively for the simulations with greatest impingement. For the kinematics applied, the results show that small differences in graft size and insertion site location may lead to large increases in impingement force and contact area. The study aims to improve ACLR success rates by understanding how minor variations in graft size and insertion site location affect intercondylar notch impingement. Because minor variations in insertion site location during ACLR are a known occurrence, the results of this study may support the argument for performing notchplasty during ACLR.

The reconstruction technique of the human anterior cruciate ligament (ACL) has been improved in the last decade. Current ACL reconstruction surgery aims to make femoral bone tunnels for graft fixation as close to the anatomical position of the ACL insertion site; the posterior-superior border of the lateral wall of the intercondylar notch of the femur1,2). Such a surgical technique is called “anatomical ACL reconstruction”. Biomechanical studies indicated that joint stability is highly restored in the anatomical ACL reconstruction as compared with the conventional ACL reconstruction3). In addition, the cortical bone beneath the ACL attachment site is thicker4), therefore it is beneficial to use the area for graft fixation. In order to succeed the anatomical ACL reconstruction, it is the most crucial to microscopically identify the anatomical site of the ACL insertion site. Previous studies indicated that the Resident’s ridge is located just anterior to the ACL femoral attachment4–6), therefore, can be used as a reference landmark for the anatomical ACL reconstruction. Although the Resident’s ridge seems to win endorsements of the role in the ACL reconstruction, no explanation was proposed so far as regard with the reason for ridge formation. The author believes that the formation of the Resident’s ridge can be biomechanically explained. Therefore, the objective of the present study was to propose a biomechanical hypothesis as regard with the Resident’s ridge formation, and to validate the hypothesis through a finite element method (FEM) analysis of ACL force-induced bone remodeling.